Caesarean disasters

Each birth is as unique as the baby it produces. While many would rather opt for the vaginal childbirth, not all are as lucky. The other option is the Caesarean Section; but many women are taking things too far by going under the doctor’s knife one time too many. YETUNDE OLADEINDE takes a look at the challenges for maternal mortality.

About two months ago, a 37-year-old mother of four was taken to the ECWA Hospital, Kano, to deliver her fifth baby. It was her fifth Caesarian Section otherwise known as CS, and the doctors battled to save her life. Unfortunately, she died moments after undergoing the operation while the baby survived.

The cost of a Caesarean Section is also something that is expensive for the average Nigerian family. Due to the poverty level of the family, her husband, Chidi Eze, who hails from Nsukka, Enugu State, lacked the financial muscle to offset the N120, 000 charged by the first hospital. She was rushed to the ECWA Hospital along Airport Road, Kano, where she was eventually admitted.

But as fate would have it, moments after she was safely delivered of the baby boy, her body chemistry became unstable, degenerating from bad to worse and finally she gave up the ghost.

The big question therefore has been what could have gone wrong? Could it be that she was endangered because she had the CS five times? Upon investigation, it was discovered that her first child died at birth and the ages of her four children range between eight, six, four and two respectively before the last.

A Kano-based medical practitioner, Dr Frank Akabugu, who spoke to The Nation right after the incident, said the most important thing is to seek help from qualified professionals when it comes to any operation. “Any mother can undergo more than five caesarian sections and remain alive, as long as a qualified doctor carried out the Caesarean Section,” he said. He, however, advised upcoming couples to embrace birth control measures, rather than embark on incessant CS.

Medical personnel don’t just decide to carry out CS on any pregnant woman; it is usually to save the life of either the mother or child, or both. On her part, Dr Temitope Akpelishi starts by taking explaining the process and the situations that warrant a CS. “A C-Section or Caesarean Section is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In certain circumstances, a Caesarean Section is scheduled in advance. In others, it is done in response to an unforeseen complication.”

Next, she goes on to talk about some of the indications for CS, which she classified as emergency indications and classical CS indications. “The emergency indications include: Foetal distress/Prolapse cord, Obstructed labour and Obstetrics complications, such as Placenta praevia. On the other hand, the classical Caesarean Section indications include preterm delivery with poorly formed lower uterine segment, Placenta praevia/Abruption placenta, Transverse lie, Severe adhesions in the lower uterine segment and the twin or multiple gestation.”

Akpelishi added that “the complications can arise from surgery and also anaesthetics used. Main problems are thrombo embolism, infection and haemorrhage, which can be minimised by giving appropriate antibiotics and good surgical practice.”

Now, you ask Akpelishi how many CS a woman can have. “It has been discovered that each repeat of C-Section is generally more complicated than the last. Studies show that risks increase after a third Caesarean delivery and vaginal deliveries are not recommended after three sections. However, research has not established the exact number of repeat Caesarean Section that can be done.”

Life, interestingly, is changing in the maternity ward these days and more women go through the caesarean operations to have their babies.

It is a preferred option for some others due to complications during childbirth, to save the life of the mother and child.

Even though the rationale for many is safety, there are some Caesarean operations that have brought sorrow and tears to family members of the victim. In Lagos, there was another sad case where the woman also died. Here, Drs Morenike Olaniyi and Abidoye Gbadegesin of Ifako-Ijaiye General Hospital were allegedly accused of causing the death of Kemi Fadehan, a pregnant woman while delivering her of a baby. What really happened? According to Lanre Fadehan, husband of the late Kemi Fadehan, Dr Olaniyi reportedly sliced the woman’s intestine in error while performing an operation to bring out the baby.

Fadehan alleged that the more experienced Dr Gbadegesin, who is a consultant, left his duty to the junior practitioner Olaniyi, who performed the surgery on his late wife. Tears and hisses, but all these cannot bring back the late Kemi, a 38-year-old mother-of-three and double Masters’ degree holder, who was scheduled to travel to the US for her PhD this year.

Sadly, the doctor allegedly ruptured the patient’s intestine during the surgery to deliver the baby and did not realise her error until about 10 days later. When it was eventually discovered, a corrective surgery was carried out, but by this time the rupture had caused a widespread infection that led to multiple organ failure, over-the-roof temperatures, nervous system breakdown and overwhelming sepsis that eventually caused the death of the woman.

Like Fadehan, Doris Ekanem tells the story of her younger sister’s experience and how it made her really scared of operations. “The interesting thing is that my sister is also a nurse, in fact a matron. So, we had a lot of confidence because she was working in the hospital. When they did the operation for her, everything went well and we were all happy to see her and the baby.”

Just when they thought all was well, her sister noticed that pus was coming out of the spot where the operation was done. “We had to take her back and they had to do another operation for her in the same hospital. It was a General Hospital in Port Harcourt and it was then that they found out that some items were forgotten in her stomach during the operation. The pain which was more severe than the first operation and emotional trauma that she went through made me so sad.”

Mrs Jumoke Babatunde (not real name) was a happy, boisterous, yet easy-going woman. She was married to Segun, the love of her life and a young marketing executive. By African standards, it was a fruitful marriage, as she got pregnant within the first few months into their marriage. So everybody was happy, the husband’s family especially. There was, however, a snag. After a prolonged labour, the doctors decided right in the labour room that she could only be delivered through a CS. Thankfully, it was a success and they had their first child, a boy. Just over two years later, she got pregnant again. Both husband and wife hoped it would be a girl. They also prayed quietly that the delivery would be uneventful and she would deliver the normal way. But probably due to apprehension, Jumoke’s courage and energy failed her at the last moment. Again, she needed the doctor’s knife. Again, it was successful. Or so they thought, until they discovered that the baby boy wasn’t urinating. They took him to different hospitals, but the little boy eventually gave up the ghost.

It was a sad moment for husband and wife. Jumoke was particularly saddened by the baby’s last moment and the pains she thought he must have gone through due to his inability to urinate. She spoke of how she could not forget easily the baby’s shrieking cry of pain. But time heals; and she soon managed to put the thought of that loss at the back of her mind. Life goes on. Over a year later, she got pregnant again, and this time, scan showed it was a girl. Once beaten, twice shy, she took her ante-natal appointments very seriously and never missed any appointment or medication. As the day of delivery approached, her doctor told her that due to some technical jargon, she would again have to deliver through CS. He, however, assured her that all would be well. As the day approached, Jumoke confessed to her hubby and friends her fear, but she was encouraged. On the D-day, she was wheeled into the theatre, almost reluctantly, but she survived. She recalled her joy at coming back to life and seeing her baby boy by her side. She was full of joy and praises to God for her safe delivery. And she named the boy Aanu-Oluwa (Mercy of God). That was in addition to his Muslim name.

But the doctor also warned her that this would be her last child. She was not to get pregnant again else things may take a more dangerous turn. She and her husband were advised on contraceptive measures and warned sternly on trying for another pregnancy. They accepted their fate and moved on. The contraceptive measures also seemed to work, until one month when Jumoke noticed that she hadn’t seen her period for almost six weeks. Even though her period had become irregular, her heart nevertheless skipped some beats. She must not get pregnant. This must not be a pregnancy, she chided herself. But they soon confirmed that it was indeed a pregnancy and another baby coming. Jumoke’s world literally collapsed. As told by her husband, they tried all sorts of measures to force out the pregnancy, but it did not happen. By the time the reality dawned on them, the foetus had grown and all they had left was to pray. Needless to say, Jumoke became a shadow of her old self. Finally, she was operated upon on the day of delivery. The baby, a girl, came out alive, but not so Jumoke. She was wheeled out of the theatre, dead.

As narrated by her husband, Wasiu, it is one moment that still haunts him. How on earth did they make that mistake? Perhaps it was destiny, he reasoned. That was his only solace as a Muslim, but he truly wished she never got pregnant that one more time. Or at least had survived by some miracle.

Temidayo is alive and hearty. But that is because she is fighting herself to keep to her doctor’s advice. Married to a husband from Delta State where the people value male children, she is perpetually unhappy that her three children are girls. She has also had to put up with snide remarks from her husband, who occasionally tells her that all she could bear him are ‘just girls.’ For this reason, she earnestly would love to try for another child. Perhaps it would be a boy. But the doctor had warned her. She has a male pelvis and can therefore not bear children the normal way. Her three girls were delivered through CS and by medical standard any more trial would amount to courting danger.

In her despair, she has also consulted other doctors. But the verdicts remain the same. The best she got was from a doctor at the Military Hospital in Lagos, who told her that the chances are 50-50. If she is so desperate, she should try. And so, she has kept to her fate, taking care of her girls and wishing they all turn out successful.

Ronke Badru’s case was a scare. When she had her third caesarean operation in 2015, she survived by the whiskers. “That was the toughest pregnancy and my doctor monitored me closely. Two weeks to delivery date, I had stabilised and the scan showed that the baby was okay and I could have a normal delivery. On that fateful morning, I was on my way to work when I noticed the labour pains and I had to do a U-turn to the hospital. My doctor was excited and I was taken into the labour room immediately. I spent about four hours there and I was getting weak and tired. At that point, we opted for an operation and I passed out after the injection. The operation was successful but the first two months was traumatic for me. I lost so much weight and looked like a skeleton. By the third month, I fell ill and the tests revealed that I had typhoid and I was so scared that I was going to lose my life. Luckily, I survived,” she reminisced.

Ugochi Eboh is another survivor and sadly she said that death was only one metre away when it happened to her. “It wasn’t something that I prepared for and it happened so suddenly. That was my last baby. I have six children and it was my sixth baby. When I got pregnant for that baby, I was so sad and didn’t know what to do with another baby. It was tough coping with the children in the house.”

Confused, she began to think of what to do with the pregnancy and consulted a few people around her about the matter. “When the pregnancy was about three months, I went to the hospital and the mission at that point was to flush the baby out. However, the first doctor that I met said it was impossible. I went to two hospitals and they asked me why I wanted to do it. I told them that I already have five children and they were enough. But, somehow, they encouraged me to keep the baby. I was not happy and I continued to think of what to do.”

An idea came up and at this point Ugochi believed that the baby would not survive the odds. “I started taking some concoctions and by the time the pregnancy was six months, my stomach was really small but it still survived. I had done scan and by the time the pregnancy was seven months, they told me that it looked like it was just two months old. Then when it was nine months, I went to the hospital and they told me that the baby was bridged.”

To her utmost surprise the baby survived. “That night, as I was sleeping, the water busted and I was taken to Apapa General Hospital where I registered. God really wanted to save me because the doctor who was handling my case was on duty. I got there around 9pm and the doctor came around 11pm. When he took a good look at me and the state that I was in, he told me that I could not have the baby on my own. At this point, blood started gushing out and he quickly called them to wheel me straight into the theatre. The woman who was to give me anaesthesia injection had gone and they started calling her to come back.”

In the theatre, the battle for survival continued: “It was as if God just wanted to save me. The woman told me to hold my back with a pillow and within a short period the operation was over. I heard my baby crying and it was a girl. The baby was so dark and I couldn’t believe it was my daughter. Then they took her away and I was wheeled into the maternity ward. Twenty minutes later, I began to experience excruciating pain and I started screaming. They kept telling me not to raise my head; the drug had entered my brain. The pain was just too much and I started screaming. So many things happened but God saved me. They kept telling me not to raise my head but it was a general ward and there was noise here and there. I started having terrible headache and they said that there was no drug for the headache. When I lay down, the headache stopped and as I made to get up the headache got up with me. I had never experienced such a thing in my life before and later they said I needed blood. I was so down and they gave me two pints of blood. I thank God that in spite of the challenge, my baby and I survived.”

The crux of the matter, however, is that even though there are a number of caesarean disasters, it has actually helped to save the lives of so many other women who could not have delivered their babies on their own. Health care personnel across the country have therefore advised mothers-to-be not to see giving birth through CS as a death sentence, and the earlier expectant mothers know this, the better for them